Social medical insurance only provides the most basic medical security. If you want to get a higher level of protection, individuals should choose and buy suitable commercial health insurance products on this basis. What are the advantages of commercial medical insurance? 1. Outpatient medical insurance According to the above analysis, the following outpatient expenses can be supplemented by commercial insurance. First of all, the expenses for outpatient and emergency services of the active insured within one year are less than 1800 yuan. Secondly, for the part of outpatient and emergency expenses accumulated by the insured exceeding 1800 yuan within one year, the upper limit of reimbursement through social medical insurance is 20,000 yuan, and the excess part needs to be borne by itself and can be passed on by commercial insurance. For example, if the annual outpatient expenses of an insured person exceed 4 1.800 yuan, the social medical insurance can reimburse 20,000 yuan. Except for 2 1.800 yuan, all the parts beyond 4 1.800 yuan shall be borne by individuals. In this way, if you want to get a higher level of security, you can only turn to commercial outpatient medical insurance. 2. Hospitalization medical insurance is the same as outpatient medical treatment, and social medical insurance guarantees hospitalization medical expenses in proportion. On-the-job insured personnel should also bear the corresponding conceit ratio in this respect, and can also reduce the burden through commercial insurance. For example, an on-the-job insured person spends 50,000 yuan in a 3A medical hospital due to illness. According to the corresponding reimbursement ratio, social medical insurance can reimburse 42,895 yuan, and the remaining 7 150 needs to be borne by individuals. Choosing the right health insurance products can reduce the personal burden of this part. 3. Critical illness insurance According to the author's investigation, Beijing's medical insurance coverage is the highest in the country. Even so, social medical insurance can only provide 6.5438+0.7 million yuan for individuals at most (that is, the basic medical insurance pooling fund and large medical expenses mutual fund have reached the maximum payment limit), and the excess will be borne by individuals. According to the current regulations, in order to obtain the highest guarantee of 6.5438+0.7 million yuan, the actual medical expenses should reach 22.65438+0.389 yuan. At this time, the personal burden is 565.438+0.389 yuan, the overall fund burden is 70,000 yuan, and the large medical expenses mutual fund burden is 654.38+0,000 yuan. 220 thousand yuan is enough to treat common diseases, but it is still a drop in the bucket for the treatment cost of millions of major diseases. Obviously, social medical insurance cannot fully meet the cost demand of major diseases. Individuals should choose suitable commercial critical illness insurance products and cooperate with social medical insurance to solve the challenges brought by major disease risks. 4. Commercial medical insurance that meets the needs of high-level medical services is paid by social medical insurance, that is, the treatment expenses incurred by designated medical institutions that meet the medical insurance drug list and diagnosis and treatment list. However, designated medical institutions can only provide the most general and common medical services according to the drug list and diagnosis and treatment list. If you want to use drugs and medical services that are relatively effective but expensive but not included in the medical insurance catalogue, or when you seek medical treatment in non-designated medical institutions with high quality and level of medical services (such as some private hospitals), the medical expenses incurred cannot be reimbursed and can only be borne by individuals at their own expense. In this case, high-income groups can only meet the needs of high-level and high-quality medical services through high-end commercial medical insurance products. 5. Income loss insurance Social medical insurance only provides partial compensation for treatment expenses, and does not compensate for the loss of work income caused by illness and inability to work. Residents can make up for the loss of income caused by illness by purchasing relevant commercial insurance products.
Legal objectivity:
Measures for the administration of health insurance
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The term "health insurance" as mentioned in these Measures refers to the insurance that the insurance company pays the insured for health reasons or medical behaviors, mainly including medical insurance, sickness insurance, disability income loss insurance, nursing insurance and medical accident insurance.
The term "medical insurance" as mentioned in these Measures refers to the insurance that provides protection for the medical treatment and rehabilitation of the insured in accordance with the insurance contract.
The term "sickness insurance" as mentioned in these Measures refers to the insurance that provides protection for the insured in the event of diseases agreed in the insurance contract.